The Hateful Trifecta

 

        As 2021 rolls out, one thing is becoming clear: the anti-PA rhetoric is becoming louder & louder by the minute as seen in the American Medical Association (AMA) public campaign back in November 2020, entitled  “ #stop scope creep... because patient safety isn’t a game”. Shortly after, ACEP ( The American College of Emergency Physicians), and AFPPA ( The American Family Practice Physicians Association sister physician groups are the last two physician communities to go public supporting this hypocritical agenda. These Physician groups positions are morally bankrupt since their campaigns essentially seeks to stall or halt the evolutionary progression of the scope of practice of Advanced Practice Providers, mainly, Nurse Practitioners, Physician Assistants, Nurse Midwives and CRNAs. They have not only benefited from our utilization easing the workload of their members, but also being reimbursed financially in most cases by our care services rendered to the patient population.

        Personally, do no profession owns a monopoly. Moreover, Healthcare nowadays is clearly a team effort, and all members of the team play a vital part in the care of the patient. In my opinion, most advanced practice providers  are not seeking to replace the physician, nor are anti-physicians’ per se, but rather being true physician extenders in increasing access to millions of people every year. And yes, I/we can assure the medical community as well as the patient community we know our role as well as our limitations. Sadly, but surely, there will always be cavalier advanced practice providers out there, but then again they are also seen in many other healthcare professions too including the physician community as well.

        The position of the AMA, Physicians for patient protection and the authors of the book Patients at Risk postulate that patients deserve care led by physicians --- the most highly educated trained and skilled medical healthcare professional. I / we, the advanced practice providers Community do not disagree with this premise nor deny it.

        However, what I/we object and disagree is their disingenuous hypocritical fear-mongering stance & campaign of misinformation to the American Healthcare consumer. They basically seem to build their argument on untruthful statements ( skewed out of context data ) about the safety of the health care services provided by us and other APPs.  

        This fomented inter-professional divisiveness of curtailing the modernization of PA practice at the legislative level should be viewed and considered a significant intrusion into our own affairs, thus limiting healthcare access to our fellow Americans in an already tough fragmented healthcare industry. But make no mistake about this, right now is a critical time which we shall all come together & put these turf battles to rest. Now is the time to openly chastise those who place inter-professional political ideologies or differences above the common good of the American people. 

        As a group of healthcare professionals, we should & need to stop disenfranchising or demonizing Healthcare Kindred professions. It's time for them to stop seeking to score political points with partisan lobbying allies by marketing disinformation to the general public. Quite frankly in my view, this hypocritical industry practice model is very short-sighted, professionally abhorrent if not unconscionably venomous and utterly disingenuous.   

Holding accountable our unprofessional peers.

Could you hold accountable an unprofessional or unethical peer member when providing subpar clinical care? Or fraudulently misrepresenting themselves to the world and industry @ large?

While you might think this is not your primary responsibility to be policing others, it might behoove you to think again. Why? Because, yes, we all have an ethical obligation to address unprofessional/rogue behavior. If whistleblowing makes you uncomfortable then look at the situation from a patient advocacy protective perspective. In other words, as difficult it may be to you in participating in this internal potential reporting activity, look at it from a “beneficence’” point of view.

In life, sometimes coming to terms to act can be difficult and for many of these moral quandaries it sure can lead to instances of ethical paralyses analysis.

And while these situations might be stressful and downright unpleasant or possibly time-consuming experiences, rest assured that you will be doing the right thing if you hold up your duty when time comes along requiring your ethical and moral stewardship.

Moreover, your anticipated stress level can be mitigated knowing that you’re placing the common good of the patient above your own interests as opposed of those culpable transgressing providers that breached  their own Hippocratic oath.

By reporting the wrongdoer to the medical licensing boards or state society you’re weeding out the so called “bad apples” in the community. You will be safeguarding a patient’s life by eliminating the potential harm that a patient would have been placed under the egregious provider. So when dealing or grappling with an unethical or unscrupulous peer provider, be the “Good Samaritan”. Don't coward or turn a blind eye--refuse to be an accomplice of this maladaptive professional behavior. Call it out. Be intolerant of any fraudulent activities...be the vigilant reporter, the vigilant voice your conscience calls you to be.

OTP Initiatives: The new Great Divide—does it need to be?

 

As a professionally diverse community of healthcare providers you couldn’t find a hotter topic of debate these days than OTP. As we continue to evolve and grow, we continue to face challenges and threats both at the internal and external level. And as a group, we are familiar with these ever evolving and/or recurring challenges that present as barriers, hurdles, etc. while often times demanding change of direction or even collective agreement on these various threatening perspectives.

OTP initiatives, depending on which camp you stand is something some of our own appear to be struggling with. On one hand the proponents seem to like the idea of its immediate relevant practice benefits in the marketplace, yet, conversely, the opponents seem to fret some uncontrollable potential repercussions such as physician groups becoming unsupportive or distancing themselves from the PA community. Proponents feel this initiative will level the playing field in the marketplace, by assuring us employment parity. Therefore, they hope and wish to move forward. Sadly, some opponents & even some PA organizations are openly favoring the status quo ( i.e. PAEA, ARC-PA )—not exactly a visionary position by these leading organizations. Myopically they view OTP as a de-stabilizer mostly of our outdated statutes & legal co-dependency in our working relationships with physicians. This in-fighting is becoming scary stuff, by creating confusion & fostering paralysis analysis in many levels.

But more scarier is the fact that some physician organizations( i.e., The AMA, the AFPA,etc.) are trying to forestall our rising momentum by using delegitimization tactics by undermining our calling into question of our role and efficacy. It’s obvious in this gate-keeping bullying role, all they’re trying to do is maintain/foster our longstanding legal co-dependency. Thus, now we find ourselves in the fight of our lives since restriction of trade can become a very tangible reality in our careers.

For OTP supporters we know how imperative & crucial this is—we must not allow the ongoing perpetuation of their self-serving selfish agendas, of lies and misinformation.

We have seen plenty of “intimidating “naysayers” about our profession throughout our evolution and development. Rest assured these situations are not new to us. Rest assured, that we will never cower from inside detractors nor from outside non-supporters.

I know that our firm resolve will prevail because we have celebrated so many other victories for so many other threats and/or struggles we have faced. I/We OTP supporters must stand strong and not waiver in these times of turmoil and internal strife regardless of how bleak or detrimental OTP detractors characterize it..

The time is now, not to hesitate but to move forward and modernize PA practice Acts all across the land. Let’s do this together,  recognizing OTP is the next chapter in our history, rightfully ours…we have earned it!

Why are Physician Assistants’ so misunderstood by everyone—even Physicians?

 

For all the accolades the PA profession receives from time to time in the print media, we, for all practical purposes still remain an enigma in many circles. And one can see this paradox very easily when we are misperceived or mischaracterized by the various media outlets; including reporters, writers, all disparaging us and referring about us with incorrect or very outdated information. So the question becomes this: why are PAs so misunderstood by everyone else including physicians? As a PA myself, I will try to explain these contributing factors objectively, however, it will become clear that these explanations are based on my experiences and observations acquired and developed over the past 30 years. Nevertheless, I will attempt to be objective & as factual as possible when dissecting this subject matter into its respective root causes listed below.

1.    A New Profession—As a profession, we just celebrated our 54^th anniversary this year. As a result, one can see that our “recentness” unlike other more established occupational fields such as medicine, nursing or engineering that ours is so new in the workforce that it can easily lead to misperceptions, or even gross mischaracterizations. Unfortunately, this becomes part of this problem when all the stakeholders are unaware or unfamiliar with who we truly are as a professional group.

                 2. A Misnamed Profession— Tragically our professional designation has not kept with the ever evolving healthcare industry. Painfully we [ the PA community ] have grappled with the name change game far too long. Moreover, our hesitancy and ambivalence have perpetuated this awful professional misnomer which continues to fail us in so many ways. For instance, it mischaracterizes our scope of practice to other stakeholders or it does not distinguish our concept from other less trained groups. This archaic inaccurate professional designation robs us of other stakeholders to clearly comprehend our role in the team-based model nowadays practiced nationwide.

              3. A Silent Profession—Collectively, we have become a timid, non-assertive group of healthcare professionals. In one hand  we’re professionally insecure, while on the other, as a community we have a sense of professional complacency. We seem to see ourselves as “I am just the PA”, this acquired an difficult to discard self-abnegation mindset makes us look powerless. It’s very obvious this psychological chain that bind us does nothing to help or advance our agenda, particularly when so many other kindred allied health professions  are feeling emboldened and empowered in advancing their agenda even if it ruffles others along the way.

 It becomes clear that this attitudinal behavior of ours is a significant barrier that must be discarded at once if we’re to move forward and not implode along the way. Resilient we must be, but truthfully without a “Darwinian outlook” (seeing ourselves as the fittest in the marketplace) then we will not.

                 4. Non-partnered Profession-- Symbiotic business relationships are very much needed if not a must. Nothing could be more detrimental than isolation or detachment from a business perspective. We have witnessed the meteoric ascension of the nursing profession (namely NPs) because of the open business community support. It has been very noticeable how these strategic business alliances have advanced their agenda and boosted their marketplace confidence. Three examples of this can be seen with their recent partnership with The AARP and their longtime associations with Johnson and Johnson, The Robert Johnson Foundation (a provider of corporate financial support of various nursing research projects throughout the years). This is one area where we have failed to pursue aggressively and miserably.

5. A Disrespectful Media— Sure we have all seen the titles: “PAs the hottest career” or “Fast track to a profitable career”, on the covers of Forbes or US News magazines.  But these are not the articles I’m referring to because they seek to provide a quick road map for thousands of graduating High Schoolers or college grads seeking potential objective information to aid them when making a final career choice.

I’m referring to the articles where PAs are bashed to the nth degree by insecure  virulent physicians or others trying to dissuade our significant industry contributions under the patient-safety rhetoric. This activity is inexcusable whether is mockingly done or the blatant inconsistent reporting which never ceases to amaze me. This media liberty taken upon themselves should be stopped because these negative descriptors of our profession does us a great disservice. How you may ask? When you hear, read these inaccurate pieces it becomes clear no fact checking has taken place. By showing a lack of basic understanding of our profession it does more harm to our name by delegitimizing our name or devaluing our credibility. Especially when our training, qualifications are questioned or minimized to the lay public. Sadly, with so much technology and availability it still boils down to ignorance and lack to exercise responsible reporting in my view.

                 6. Brandless Profession-- It continues to astound me to this date that we lack a strong professional identity (a distinctive brand). Thus, is it any wonder why so many stakeholders don’t get who we are or what we exactly do? How can they? Basically, the onus is on us—no one else, if we expect people to know our “brand” then we will need and could use some more name recognition but only if our leaders/community pursues a wide systematic marketing campaign across the country. Raising PA-awareness for all practicing PAs across all communities will bring us to the XXI-st century and create a connection with others who we work with—something so much needed, we’re not “doctors-wanna-be” or “glorified scut monkeys”. Let it be known that we’re accomplished professionals in our own rights (period). We no longer should be viewed as a subservient profession, we ought to stamp out this seemingly never-ending need to clarify or justify our industry role.

In sum & simply said, we need to be more vigilant, more active (engaging) with the world if we expect to be respected, recognized, appreciated and ultimately understood. The days of “I’m just a PA” should be over. Instead, we should be epitomizing/practicing the essence of this quote: “Change isn’t made by asking permission, but rather asking for forgiveness-- later” (Seth Godin, author of Tribes: We need you to lead us). Thus, misunderstanding of our profession would be much less…I would think.

 

 

“The Opioid Crisis: The way I see it…”

      The other day as I was driving home after work, I recalled listening to a brief NPR report on the Opioid Crisis. For the rest of the day I couldn’t help myself to think how did we get into this awful mess in the first place. Specially now several years later after all the deadly costs associated with this ongoing public health calamity ravaging so many communities throughout the country with no end in sight.

           I think we must have to acknowledge that this mess did not arise form ignorance nor stupidity…or did it? But, at a closer look it arose, instead from corporate unethical behavior & deplorable corporate greed. Retrospectively, in essence, all the circumstances & factors seem to have been ripe for the back then perfect storm (the creation of the Opioid crisis in the US/world as we know it today).

         During that time JACOH came out with a call for the medical community of prescribers to take stock of their ineffective role of controlling pain across the boards. Hence, “Pain: The Six Vital Sign” campaign ensued furiously. Naturally Big Pharma  probably felt this was their “green light” and moral justification to flood the market with opioids, after all it was us-- the medical community-- who undertreated (knowingly) pain for decades. Did we get framed for material gain alone or for their wider and deeper corrupt ends? Or didn’t the apparent consequences appeared foreseeable to all 3 stakeholders?  

        Perhaps, civic altruism let us astray during esthat time as in so many witnessed cases throughout history. Or perhaps as some of us would quickly point out or say, nothing more than The Law of Unintended Consequences playing itself out at its best. Or did we forgot to seek scientific guidance or take moral stock of our practices.

 As all 3 stakeholders scrambled to lay the blame ( point fingers for this unimaginable fiasco ) it becomes clearer to this author that we the medical prescribing community have been by far the most vilified group directly or indirectly by the media when in reality equity apportionment is missing to this day in most articles, op eds, essays, etc. covering this controversial subject matter.

 At this fork in the road, we should all continue to strive and remain committed to the vigorous pursuit of the truth (wherever that may lead) and persistent attention to the purposes for which these truths may be put in service. Moreover, how our actions or transactional inactions may compromise reflections of our individual and collective ethical values. The way I see it, we felt impotent in mitigating the opioid crisis when we had an opportunity all because we abdicated our role of patient advocates. Initially we should have spoken the truth even when it would have been difficult to disagree with the industry prevailing point of view..

 The way I see it, we should have known better... even big Pharma.